The nasal valve is the most important region responsible for air flow and nasal resistance. In the past five years, numerous advances have been made in nasal valve analysis and surgery. The discovery that the valve consists of two distinct regions, the external and internal valves, has led to tailored surgical techniques to improve each site independently. Improved objective tests using rhinomanometry, acoustic rhinometry, and magnetic resonance imaging have proven that certain surgical techniques will improve nasal valve function. The roles of septoplasty, inferior turbinate surgery, and cartilage grafting have been objectively analyzed and methodically delineated. The nasal valve is now a prominent factor in planning cosmetic and functional rhinoplasty. This review examines the recent developments in nasal valve surgery and fits them into historical perspective with the evolution of our understanding of the nasal valve.